Things to Ponder Before and After a Surgery on Your Skin

As part of the aging process our skin progressively loses its elasticity and our muscles tend to slacken. The stresses of daily life, effects of gravity and exposure to sun can be seen on our faces. The folds and smile lines deepen the corners of the mouth droop, the jaw line sags and the skin of the neck becomes slack. Around the eyes, the eyebrows droop and the skin of the eyelids gathers in loose folds. In the skin the first sign is fine wrinkles developing around the lips, at the outer corners of the eye and lines of expression. The rate at which this happens varies from one person to another and is probably determined by our genes. Substantial weight loss can produce similar changes in facial appearance to those of the ageing process.

WHO WILL BENEFIT?

The best candidate is one whose face and neck has begun to sag, but whose skin still has some elasticity and whose bone structure is strong and well defined. Most patients are in their 40’s to 60’s, but facelifts can be done successfully on people in their 70’s or 80’s.

It should not be obvious that a patient has had a facelift, but instead they look younger, more vital and cheerful. It is a procedure that technically works well but also increases morale and is well appreciated by the patient.

BEFORE THE OPERATION

If you are overweight and intend to lose it you should do so before the operation. This allows the surgeon to remove more skin and therefore achieve a more pleasing result. You should avoid taking tablets containing aspirin and non steroidal anti-inflammatory drugs such as Combiflam or Brufen for at least two weeks before surgery as they increase the risk of bleeding.

You should stop smoking at least two weeks before surgery as this is the main cause of reduced healing. It decreases circulation of the skin flaps, particularly behind the ears. Have your hair permed and tinted, if you wish, before your operation as fresh scars are sensitive to these chemicals for a few weeks.

THE OPERATION

A facelift is carried out under general anaesthesia. It is possible to carry out the procedure under local anaesthetic and intravenous sedation but the patient would still be advised to spend the night in hospital. The procedure, although long, can be combined with other operations of all sorts. The most common however would be an forehead or brow lift and an eyelid surgery (Blepharoplasty). Other extra procedures which can be used to enhance the face at the same time are malar (cheek bone) and chin augmentation and lip enhancement.

Forehead lift is designed to tighten the skin of the upper half of the face, as opposed to the standard facelift which helps the lower half of the face.

Incisions are made above the hair line at the temples and extend in a natural line down the front of the ear, or just inside the cartilage at the front of the ear, and continue around behind the earlobe and up in the crease behind the ear and off into the lower scalp. Occasionally it may be necessary to make a small incision under the chin. Sometimes only the skin is lifted following separation from the underlying platysma muscle (Classical Facelift).

More usually however the platysma muscle and its fibrous attachments (S.M.A.S.) is dissected free and sutured tightly to the solid structures in front and behind the ear. At other times the skin and the S.M.A.S. layer are lifted together as a single layer, but will still be sutured separately. (SMAS Facelift). Fat along the jaw line and under the chin may be removed by liposuction or on occasion through an incision under the chin. The skin is sutured so that it is lifted upwards and backwards. Sometimes drains are inserted. Most surgeons will bandage the face to minimise bruising and swelling. These bandages will stay for one or two days and the sutures are removed in 7 to 8 days.

LIMITATIONS

A facelift works better for the lower half of the face and particularly the jaw line and neck. If you have sagging eyebrows and wrinkles of the forehead then you should perhaps consider a brow lift. This can be performed surgically or endoscopically. Loose skin with fine wrinkles, freckles and rough areas will benefit more by chemical peel or laser resurfacing.

A facelift does not stop the clock, but it does put the clock back. The effect of the facelift is likely to be there but it may not last forever.

RISKS

A facelift is a major surgical procedure. In facelift, complications are rare but they need to be treated promptly.

• Hematoma – a collection of blood under skin can happen and needs to be drained out.
• Nerve injury – Numbness of skin is routine but some patients have partial weakness of muscles of facial expression which is usually temporary and should recover in 6-8 weeks.
• Infection is rare and responds to antibiotics.
• Poor healing is seen mostly in chronic smokers.
• Scars are usually fine and well hidden. In some individuals they tend to become thick and red (Hypertrophic scars) and can be helped with steroid injection.

AFTER THE SURGERY

After your surgery there is usually some bruising of the cheeks and with gravity this tends to descend into the neck. Discomfort is usually mild and can be controlled with analgesics. It is normal for there to be some numbness of the skin of the cheeks and ears. This will usually disappear in a few weeks or months. It is better to keep the head elevated for a couple of days to reduce swelling. Drainage tubes will be removed a day or two after surgery. Avoid strenuous activity, saunas and massage for at least two weeks.

At the beginning your face will look a little puffy and may feel rather strange and stiff. The scars can be very well hidden by women with their hair and disc shaped earrings so that they should be able to resume work and social activities within a couple of weeks. Camouflage make-up can be helpful in masking bruising.

Men find it more difficult to disguise the scars and will need to shave their beard closer to the ear in front and also behind the ear where the skin has been lifted. The scars in the hair do not usually show except that the hair is cut shorter immediately around the wound. There may be some slight reduction in hair growth in the temples, but this is not usually a problem unless the hair is very thin and repeated facelifts are being carried out.